Access Preparation Mandibular Molar: Case I: Advanced Endodontics: Dr. Ruddle

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The access preparation is an essential element for successful endodontics. Preparing the endodontic access cavity is a critical step in a series of procedures that potentially leads to the 3-D obturation of the root canal system.
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I prefer three different horizontally angulated films in this straight on view you can see looking ahead to access that we're going to be making a window through a gold crown notice the Popol floor and the Popol roof are almost contiguous you can see the horns extending up off the floor in the mesial distal dimensions and some evidence of Popol stones once we have sufficiently isolated the tooth to be treated in tonically then we're ready to begin to envision our access outline pattern there's an old expression start with the end in mind I like to use the transmittal bur it will reduce a lot of unwanted vibration lay the head of the handpiece over on its side to make the bur more of a side cutting or rather than an in cutting bur it's important to create a little window almost immediately so we can use the side of the bur to begin to remove gold and to get access into the underlying dentin be sure to have a good finger hold because sometimes these burrs like to skip or skate when you have a metal bur on a metal restorative but you can begin to then expand the access mesial and you can begin to get prepared to use surgical length instruments a surgical length number for round bur allows us to brush in a mesial distal direction the assistant can blow air in through the straw PO to evacuate the dust of the high-speed suction we work progressively mesial distal until we uncover a little bit of the Popol chamber notice I'm showing you the access pattern it's incomplete but it's beginning to expand and of course it'll be finalized once we find the focal floor and the related orifices you can notice that this is a large stone I'm uncovering and my bird doesn't actually fall into a pulp chamber mapping this stone you can begin to see it's quite large its immobile it's going to require some resection to free it up so using a surgical length diamond with 12 millimeters of cutting abrasive we can begin to flatten out our walls we are expanding our access walls axially to the mesial now if the stone is exposed fully ultrasound is a very good adjunct to break these things up sometimes they'll disintegrate into countless pieces and other times you'll have the pleasure of removing a fairly significantly sized stone notice the occlusal gingival dimensions anybody can cut a hole into a tooth but your great clinicians like to finish those holes superbly notice the walls are all nice and flat this allows us to reflect light off those walls so we can see Popol floor anatomy better you can notice that there's more denticles overlying the distal systems and an explorer's begin to tease out a small little denticles that could inadvertently get pushed deeper into the canal if we don't take the time to thoughtfully remove these stones air evacuation can blow them out once they're free well we just removed a very large stone from the pulp chamber but recalling and ended on eclis involve teeth it is normal for orifices to constrict and recede and we must be very careful that we remove even stones that lies slightly below the popo floor in this instance you can see a 10 file is bringing up a small dent achill so we can make room for the X gates to pre-flare the orifice by rolling the handpiece and a big orbital arc above the X gates orifice pivot point we can pre-flare that orifice and we can ramp it out so that it is married to the axial walls and this will give us a smooth entry pattern during subsequent instrumentation ultrasonic technology is playing an increasing role in excess cavity finalization here we're using a pro ultra tip draw I the air blows out the byproduct of our sanding action was as dentinal dust and we run along between the MB and m/l interconnector within this groove in mandibular molars one can occasionally find a mid mesial system if we never explore for this we'll never find it now remember when you have a mid mesial it's right against the depth of the Furcal site concavity so we must shape this canal smaller than we would actually prepare the MB in ml systems ultrasound can smooth and refine and do precise amounts of detailed work reserve your tapered diamonds for doing, larger work there's water port technology if you prefer to cut wet and to float and surf out some of the remnants of our work in the post-operative film you can

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